Publications by authors named "Andy Husband"

20 Publications

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'He or she maybe doesn't know there is such a thing as a review': A qualitative investigation exploring barriers and facilitators to accessing medication reviews from the perspective of people from ethnic minority communities.

Health Expect 2022 Apr 5. Epub 2022 Apr 5.

School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.

Introduction: Regular reviews of medications, including prescription reviews and adherence reviews, are vital to support pharmacological effectiveness and optimize health outcomes for patients. Despite being more likely to report a long-term illness that requires medication when compared to their white counterparts, individuals from ethnic minority communities are less likely to engage with regular medication reviews, with inequalities negatively affecting their access. It is important to understand what barriers may exist that impact the access of those from ethnic minority communities and to identify measures that may act to facilitate improved service accessibility for these groups.

Methods: Semi-structured interviews were conducted between June and August 2021 using the following formats as permitted by governmental COVID-19 restrictions: in person, over the telephone or via video call. Perspectives on service accessibility and any associated barriers and facilitators were discussed. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the Health Research Authority (ref: 21/HRA/1426).

Results: In total 20 participants from ethnic minority communities were interviewed; these participants included 16 UK citizens, 2 refugees and 2 asylum seekers, and represented a total of 5 different ethnic groups. Three themes were developed from the data regarding the perceived barriers and facilitators affecting access to medication reviews and identified approaches to improve the accessibility of such services for ethnic minority patients. These centred on (1) building knowledge and understanding about medication reviews; (2) delivering medication review services; and (3) appreciating the lived experience of patients.

Conclusion: The results of this study have important implications for addressing inequalities that affect ethnic minority communities. Involving patients and practitioners to work collaboratively in coproduction approaches could enable better design, implementation and delivery of accessible medication review services that are culturally competent.

Patient Or Public Contribution: The National Institute for Health Research Applied Research Collaboration and Patient and Public Involvement and Engagement group at Newcastle University supported the study design and conceptualization. Seven patient champions inputted to ensure that the research was conducted, and the findings were reported, with cultural sensitivity.
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http://dx.doi.org/10.1111/hex.13482DOI Listing
April 2022

An e-Delphi study to obtain expert consensus on the level of risk associated with preventable e-prescribing events.

Br J Clin Pharmacol 2022 Feb 16. Epub 2022 Feb 16.

School of Pharmacy, Newcastle upon Tyne, UK.

Aims: We aim to seek expert opinion and gain consensus on the risks associated with a range of prescribing scenarios, preventable using e-prescribing systems, to inform the development of a simulation tool to evaluate the risk and safety of e-prescribing systems (ePRaSE).

Methods: We conducted a two-round e-Delphi survey where expert participants were asked to score pre-designed prescribing scenarios using a five-point Likert scale to ascertain the likelihood of occurrence of the prescribing event, likelihood of occurrence of harm and the severity of the harm.

Results: Twenty-four experts consented to participate with 15 pand 13 participants completing rounds 1 and 2, respectively. Experts agreed on the level of risk associated with 136 out of 178 clinical scenarios with 131 scenarios categorised as high or extreme risk.

Conclusion: We identified 131 extreme or high-risk prescribing scenarios that may be prevented using e-prescribing clinical decision support. The prescribing scenarios represent a variety of categories, with drug-disease contraindications being the most frequent, representing 37 (27%) scenarios, and antimicrobial agents being the most common drug class, representing 28 (21%) of the scenarios. Our e-Delphi study has achieved expert consensus on the risk associated with a range of clinical scenarios with most of the scenarios categorised as extreme or high risk. These prescribing scenarios represent the breadth of preventable prescribing error categories involving both basic and advanced clinical decision support. We will use the findings of this study to inform the development of the e-prescribing risk and safety evaluation tool.
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http://dx.doi.org/10.1111/bcp.15284DOI Listing
February 2022

A qualitative exploration of the barriers and facilitators affecting ethnic minority patient groups when accessing medicine review services: Perspectives of healthcare professionals.

Health Expect 2022 Apr 23;25(2):628-638. Epub 2021 Dec 23.

School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK.

Introduction: Healthcare inequalities and ethnicity are closely related. Evidence has demonstrated that patients from ethnic minority groups are more likely to report a long-term illness than their white counterparts; yet, in some cases, minority groups have reported poorer adherence to prescribed medicines and may be less likely to access medicine services. Knowledge of the barriers and facilitators that impact ethnic minority access to medicine services is required to ensure that services are fit for purpose to meet and support the needs of all.

Methods: Semistructured interviews with healthcare professionals were conducted between October and December 2020, using telephone and video call-based software. Perspectives on barriers and facilitators were discussed. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the Newcastle University Faculty of Medical Sciences Ethics Committee.

Results: Eighteen healthcare professionals were interviewed across primary, secondary and tertiary care settings; their roles spanned medicine, pharmacy and dentistry. Three themes were developed from the data regarding the perceived barriers and facilitators affecting access to medicine services for ethnic minority patients. These centred around patient expectations of health services; appreciating cultural stigma and acceptance of certain health conditions; and individually addressing communication and language needs.

Conclusion: This study provides much-needed evidence relating to the barriers and facilitators impacting minority ethnic communities when seeking medicine support. The results of this study have important implications for the delivery of person-centred care. Involving patients and practitioners in coproduction approaches could enable the design and delivery of culturally sensitive and accessible medicine services.

Patient Or Public Contribution: The Patient and Public Involvement and Engagement (PPIE) group at Newcastle University had extensive input in the design and concept of this study before the research was undertaken. Throughout the work, a patient champion (Harpreet Guraya) had input in the project by ensuring that the study was conducted, and the findings were reported, with cultural sensitivity.
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http://dx.doi.org/10.1111/hex.13410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8957739PMC
April 2022

Correction to: Polypharmacy definition and prevalence in heart failure: a systematic review.

Heart Fail Rev 2022 Mar 31;27(2):739. Epub 2021 Jul 31.

NHS Greater Glasgow and Clyde, Glasgow, UK.

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http://dx.doi.org/10.1007/s10741-021-10149-yDOI Listing
March 2022

Polypharmacy definition and prevalence in heart failure: a systematic review.

Heart Fail Rev 2022 03 2;27(2):465-492. Epub 2021 Jul 2.

NHS Greater Glasgow and Clyde, Glasgow, UK.

Polypharmacy and heart failure are becoming increasingly common due to an ageing population and the rise of multimorbidity. Treating heart failure necessitates prescribing of multiple medications, in-line with national and international guidelines predisposing patients to polypharmacy. This review aims to identify how polypharmacy has been defined among heart failure patients in the literature, whether a standard definition in relation to heart failure could be identified and to describe the prevalence. The Healthcare Database Advanced Search (HDAS) was used to search EMBASE, MEDLINE, PubMed, Cinahl and PsychInfo from inception until March 2021. Articles were included of any design, in patients ≥ 18 years old, with a diagnosis of heart failure; that explicitly define and measure polypharmacy. Data were thereafter extracted and described using a narrative synthesis approach. A total of 7522 articles were identified with 22 meeting the inclusion criteria. No standard definition of polypharmacy was identified. The most common definition was that of " ≥ 5 medications." Polypharmacy prevalence was high in heart failure populations, ranging from 17.2 to 99%. Missing or heterogeneous methods for defining heart failure and poor patient cohort characterisation limited the impact of most studies. Polypharmacy, most commonly defined as ≥ 5 medications, is highly prevalent in the heart failure population. There is a need for an internationally agreed definition of polypharmacy, allowing accurate review of polypharmacy issues. Whether an arbitrary numerical cut-off is a suitable definition, rather than medication appropriateness, remains unclear. Further studies are necessary to understand the relationship between polypharmacy with specific types of heart failure and related comorbidities.
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http://dx.doi.org/10.1007/s10741-021-10135-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250543PMC
March 2022

Support for Healthcare Professionals After Surgical Patient Safety Incidents: A Qualitative Descriptive Study in 5 Teaching Hospitals.

J Patient Saf 2021 08;17(5):335-340

Department of Sociology, Durham University, Durham.

Objective: Patient safety incidents can have a profound effect on healthcare professionals, with some experiencing emotional and psychological distress. This study explored the support medical and nonmedical operating room staff received after being involved in a surgical patient safety incident(s) in 5 UK teaching hospitals.

Methods: An invitation letter and information sheet were e-mailed to all medical and nonmedical operating room staff (N = 927) across the 5 sites. Semistructured interviews were arranged with a range of different healthcare professionals working in operating rooms across a wide variety of surgical specialities. Interviews were audio recorded, transcribed verbatim, and analyzed using an inductive thematic approach.

Results: We conducted 45 interviews with medical and nonmedical operating room staff, who emphasized the importance of receiving personalized support soon after the incident. Operating room staff described how the first "go to" people were their peers and reported feeling comforted when their peers empathized with their own experience(s). Other participants found it very difficult to seek support, perceiving it as a sign of weakness. Although family members played an important role in supporting second victims, some participants felt unable to discuss the incident with them, fearing that they might not understand.

Conclusions: There should be clear support structures in place for operating room staff who have been involved in surgical incidents. Health organizations need to offer timely support to frontline staff after these incidents. Senior clinicians should be proactive in offering support to junior colleagues and empathize with their own experiences, thus shifting the competitive culture to one of openness and support.
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http://dx.doi.org/10.1097/PTS.0000000000000844DOI Listing
August 2021

Learning from safety incidents in high-reliability organizations: a systematic review of learning tools that could be adapted and used in healthcare.

Int J Qual Health Care 2021 Mar;33(1)

School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, Tyne and Wear NE1 7RU, UK.

Objective: A high-reliability organization (HRO) is an organization that has sustained almost error-free performance, despite operating in hazardous conditions where the consequences of errors could be catastrophic. A number of tools and initiatives have been used within HROs to learn from safety incidents, some of which have the potential to be adapted and used in healthcare. We conducted a systematic review to identify any learning tools deemed to be effective that could be adapted and used by multidisciplinary teams in healthcare following a patient safety incident.

Methods: This review followed the Preferred Reporting Items for Systematic Reviews and MetaAnalyses for Protocols reporting guidelines and was registered with the PROSPERO (CRD42017071528). A search of databases was carried out in January 2021, from the date of their commencement. We conducted a search on electronic databases such as Web of Science, Science Direct, MEDLINE in Process Jan 1950-present, EMBASE Jan 1974-present, CINAHL 1982-present, PsycINFO 1967-present, Scopus and Google Scholar. We also searched the grey literature including reports from government agencies, relevant doctoral dissertations and conference proceedings. A customized data extraction form was used to capture pertinent information from included studies and Critical Appraisal Skills Programme tool to appraise on their quality.

Results: A total of 5921 articles were identified, with 964 duplicate articles removed and 4932 excluded at the title (4055), abstract (510) and full-text (367) stages. Twenty-five articles were included in the review. Learning tools identified included debriefing, simulation, crew resource management and reporting systems to disseminate safety messages. Debriefing involved deconstructing incidents using reflective questions, whilst simulation training involved asking staff to relive the event again by performing the task(s) in a role-play scenario. Crew resource management is a set of training procedures that focus on communication, leadership and decision-making. Sophisticated incident-reporting systems provide valuable information on hazards and were widely recommended as a way of disseminating key safety messages following safety incidents. These learning tools were found to have a positive impact on learning if conducted soon after the incident with efficient facilitation.

Conclusion: Healthcare organizations should find ways to adapt to the learning tools or initiatives used in HROs following safety incidents. It is challenging to recommend any specific one as all learning tools have shown considerable promise. However, the way these tools or initiatives are implemented is critical, and so further work is needed to explore how to successfully embed them into healthcare organizations so that everyone at every level of the organization embraces them.
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http://dx.doi.org/10.1093/intqhc/mzab046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8271183PMC
March 2021

A qualitative study exploring the lived experience of medication use in different disease states: Linking experiences of disease symptoms to medication adherence.

J Clin Pharm Ther 2021 Apr 5;46(2):352-362. Epub 2020 Nov 5.

School of Pharmacy, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.

What Is Known: Medication non-adherence leads to negative health outcomes. Medication adherence is predicted if patients understand the necessity of medication use to control disease symptoms and progression. It could be expected then, that patients with diseases with symptoms which are managed with medications, such as chronic obstructive pulmonary disorder or gout, or diseases with high-mortality rates, such as cancer, would have higher adherence rates than asymptomatic diseases, such as hypertension. However, poor medication adherence remains problematic in both symptomatic and asymptomatic diseases. Further work is needed to explore patient experiences of medication adherence to understand the link between adherence and symptom control.

Objective: To explore patients' lived experiences of medication adherence.

Methods: Participants were recruited from community pharmacies and general practices. Forty-one semi-structured interviews and three focus groups were used to collect data from patients with disease states that had different symptomatic and asymptomatic profiles. Inductive thematic analysis was used to identify key parts of the experience of using medications.

Results: Participants reported similar experiences of medication adherence despite having different disease symptoms. Participants said that they used medications because it was an expected part of everyday life and that medications 'must be needed' because they had been supplied, rather than being used for a particular symptom. Participants reported short-term episodes of non-adherence were unlikely to lead to negative health outcomes but may result in negative social consequences.

Discussion: The findings broaden our understanding of patient experiences of medication use by indicating patients with symptomatic and asymptomatic diseases share similar experiences of medication use. The necessity to use medications appeared to come from 'the system' of healthcare professionals, family and friends that supply and recommend medications.

What Is New: There were key similarities in experiences of medication adherence in patients with different disease states. The negative consequences of short-term episodes of non-adherence were normalized by healthcare professionals.

Conclusion: Patients with symptomatic and asymptomatic diseases share similar experiences of medication adherence.
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http://dx.doi.org/10.1111/jcpt.13288DOI Listing
April 2021

Exploring the use of WhatsApp in out-of-hours pharmacy services: A multi-site qualitative study.

Res Social Adm Pharm 2020 04 29;16(4):503-510. Epub 2019 Jun 29.

School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, NE2 7RU, UK.

Background: WhatsApp is an instant messaging application that has grown in popularity over the last decade. The literature has focused on the use of WhatsApp in medical, surgical and nursing disciplines, with little work exploring pharmacists' experiences of using WhatsApp to provide services.

Objective(s): The aim of this research was to explore pharmacists' experiences of using WhatsApp to support delivery of out-of-hours pharmacy services.

Methods: A qualitative design was underpinned by a phenomenological philosophy. Focus groups and an extract of the WhatsApp transcript were thematically analysed using NVivo.

Results: Over three hundred communication events (1580 messages) were analysed in the WhatsApp transcript. Message type was classified as follows; handover (26%, n = 410), procedural queries (26%, n = 410), laptop location (18%, n = 284), whole staff communication (24%, n = 379), clinical queries (5%, n = 79), and administrative communications (1%, n = 16). A total of five focus groups were conducted between October and November 2017 with 27 participants that included pharmacists with different levels of experience. The findings suggest that WhatsApp improved communication between junior and senior pharmacists, particularly during the global cyber crisis, and provided an opportunity to share best practice. Concerns were raised regarding the encroachment of work activities into personal time. Additionally, the tacit approval by senior pharmacists to group information sharing and solution development, despite the potential for non-active participation, highlighted the issue of collective complicity.

Conclusions: WhatsApp can be a useful platform to support the delivery of out-of-hours services through professional development, improving communication and supporting relationships. This paper demonstrates that service managers must consider multiple ethico-legal and social frameworks when developing or allowing the organic development of such communication methods within healthcare provider organisations.
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http://dx.doi.org/10.1016/j.sapharm.2019.06.019DOI Listing
April 2020

A study to investigate the impact of a blended learning teaching approach to teach pharmacy law.

Int J Pharm Pract 2019 Jun 13;27(3):303-310. Epub 2018 Dec 13.

School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.

Objective: To describe the implementation and assess the effect of a blended learning approach to teach pharmacy law.

Methods: Twenty didactic pharmacy law lectures were redeveloped to 9 h of flipped classroom sessions. Presession online videos delivered factual content created in-house. In-class activities explored the application and nuances of law through simulated cases. Stage 2 Pharmacy undergraduate students (n = 69) were administered the Community of Inquiry Survey, measuring the social, teaching and cognitive presence of online learning experiences across 34 items on a Likert scale 1-5 (1 = 'strongly agree', to 5 = 'strongly disagree'). Four focus groups were undertaken and analysed thematically to explore student perceptions. Performance at the final summative law examination was recorded and compared to that of two previous cohorts given traditional, didactic teaching.

Key Findings: Fifty-three students (76.8% response) completed the survey. The mean ranking was 3.6 ± 0.7, 3.6 ± 0.6 and 3.3 ± 0.7 for teaching, social and cognitive presence, and most positively rated statements related to material design and organization. All students passed the summative law examination performing not significantly different to the previous cohorts. Focus group discussions demonstrated that students liked the online and interactive case-study materials, but wanted more direction and preferred smaller group sessions. Students had mixed feelings about needing an online social component.

Conclusions: Blended learning transformed the pharmacy law teaching from didactic to an interactive learning experience. The student feedback was generally mixed, but offered many recommendations to optimize the design and format of the course. Examination performance appeared to be unaffected by the change in teaching style.
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http://dx.doi.org/10.1111/ijpp.12503DOI Listing
June 2019

Challenges and innovations of delivering medicines to older adults.

Adv Drug Deliv Rev 2018 10 15;135:97-105. Epub 2018 Aug 15.

School of Pharmacy, Faculty of Medical Sciences, Newcastle University, UK.

Older adults with multimorbidity, polypharmacy, and complex health needs are the major consumer of health care. Ensuring that medicines are used safely, effectively, and delivered efficiently in this population is challenging. In this context, the approach to medicines delivery should seek to overcome some of the difficulties of delivering medicines to older people, and ensure each medication is delivered by the optimal and most convenient route for the patient in question. However, this poses significant obstacles, as the development of medicines suitable for use in older populations does not often account for complex health needs, potential challenges in relation to drug disposition, safety of excipients and limitations with practical usability of dosage forms. The objective of this review is to summarise and discuss current challenges and novel approaches to delivering medications to older adults.
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http://dx.doi.org/10.1016/j.addr.2018.08.003DOI Listing
October 2018

Helpful advice and hidden expertize: pharmacy users' experiences of community pharmacy accessibility.

J Public Health (Oxf) 2017 09;39(3):609-615

Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, TS17 6BH, UK.

Background: In recent years community pharmacies have emerged as strategically important settings to deliver services aimed at promoting public health. In order to develop evidence-based approaches to public health interventions that exploit the unique accessibility of community pharmacies, it is important to determine how people experience care in this context. This study, therefore, aimed to describe how care is perceived and experienced in community pharmacies with particular focus on community pharmacy access.

Methods: In-depth semi-structured interviews were used to explore the perceptions and experiences' of people using community pharmacies.

Results: A total of 30 participants were interviewed. Themes specifically emerged in relation to community pharmacy access; these fell into four main categories: relationships; time; lack of awareness; and empowerment.

Conclusions: The experience of developing a trusting relationship with the pharmacist is an important consideration in the context of community pharmacy accessibility. This could be an important consideration when a person uses a community pharmacy to access a public health service. There is also a perceived lack of awareness among the general public about the extended role of community pharmacy; this is a potential barrier toward people using them.
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http://dx.doi.org/10.1093/pubmed/fdw089DOI Listing
September 2017

Person-centred pharmaceutical care reduces emergency readmissions.

Eur J Hosp Pharm 2016 Mar 1;23(2):80-85. Epub 2015 Oct 1.

Division of Pharmacy , School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard , Thornaby-On-Tees , UK.

Background: Unplanned readmissions to hospital are used in many healthcare systems as a quality indicator of care. Identifying patients at risk of readmission is difficult; existing prediction tools are only moderately sensitive. Correlations exist between certain medicines and emergency readmission, but it is not known whether the association is direct or indirect.

Objectives: To determine whether person-centred pharmaceutical care bundles, comprising individualised medicines information, risk management and/or support in taking medicines, might prevent unplanned readmissions by improving adherence and reducing avoidable harm from prescribed medications.

Methods: We designed and implemented person-centred pharmaceutical care bundles for patients who were socially isolated and/or on high-risk medicines on one older people's medical ward for 1 year from February 2013. Another ward with similar patient demographics, service characteristics and a standard clinical pharmacy service was used as a comparator in a prospective cohort study. Readmission rates were retrospectively studied for 12 months before the intervention and during the 12-month intervention period.

Results: The readmission rates for the intervention and control wards in the 12 months before the intervention were not significantly different. During the intervention period, the readmission rate was significantly lower on the intervention ward (69/418) than on the control ward (107/490; 17% vs 22%, p<0.05, z=2.05, two-sample z test for difference in proportions of unrelated samples).

Conclusions: Person-centred pharmaceutical care bundles were significantly associated with reduced risk of emergency hospital readmission in this study. Further evaluation of the model is warranted.
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http://dx.doi.org/10.1136/ejhpharm-2015-000736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789703PMC
March 2016

'I don't think I'd be frightened if the statins went': a phenomenological qualitative study exploring medicines use in palliative care patients, carers and healthcare professionals.

BMC Palliat Care 2016 Jan 29;15:13. Epub 2016 Jan 29.

Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Thornaby, Stockton-on-Tees, TS17 6BH, UK.

Background: There is a growing body of evidence suggesting patients with life-limiting illness use medicines inappropriately and unnecessarily. In this context, the perspective of patients, their carers and the healthcare professionals responsible for prescribing and monitoring their medication is important for developing deprescribing strategies. The aim of this study was to explore the lived experience of patients, carers and healthcare professionals in the context of medication use in life-limiting illness.

Methods: In-depth interviews, using a phenomenological approach: methods of transcendental phenomenology were used for the patient and carer interviews, while hermeneutic phenomenology was used for the healthcare professional interviews.

Results: The study highlighted that medication formed a significant part of a patient's day-to-day routine; this was also apparent for their carers who took on an active role-as a gatekeeper of care-in managing medication. Patients described the experience of a point in which, in their disease journey, they placed less importance on taking certain medications; healthcare professionals also recognize this and refer it as a 'transition'. This point appeared to occur when the patient became accepting of their illness and associated life expectancy. There was also willingness by patients, carers and healthcare professionals to review and alter the medication used by patients in the context of life-limiting illness.

Conclusions: There is a need to develop deprescribing strategies for patients with life-limiting illness. Such strategies should seek to establish patient expectations, consider the timing of the discussion about ceasing treatment and encourage the involvement of other stakeholders in the decision-making progress.
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http://dx.doi.org/10.1186/s12904-016-0086-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4731932PMC
January 2016

Inappropriate prescribing of preventative medication in patients with life-limiting illness: a systematic review.

BMJ Support Palliat Care 2017 Jun 5;7(2):113-121. Epub 2016 Jan 5.

Division of Geriatric and Palliative Medicine, The University of Texas Health, Science Center at Houston, Houston, Texas, USA.

Objectives: To systematically review the literature to examine the methods used to identify inappropriate prescribing of preventative medication in patients with life-limiting illness and to detail the nature of medications prescribed.

Methods: A systematic literature search of 4 databases was undertaken (MEDLINE, EMBASE, CINAHL, PsycINFO) from inception to April 2015 to identify peer-reviewed, observational studies assessing inappropriate prescribing of preventative medication in patients with life-limiting illness. Inclusion criteria were: participants had a life-limiting illness; prescribed/dispensed/using preventative medication; medication appropriateness assessed as a specific study aim or outcome.

Results: We found 19 studies meeting our eligibility criteria. The methods used to assess medication appropriateness included criteria developed for the elderly such as the Beers Criteria, and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, Delphi consensus and expert clinical opinion. Lipid-regulating drugs (12 studies), antihypertensive (11 studies) and antidiabetic medications (9 studies) were the most common classes of inappropriate medication identified.

Conclusions: Patients with life-limiting illnesses are prescribed preventative medications considered inappropriate in the context of diminished life expectancy. The way in which preventative medication appropriateness is assessed in patients with life-limiting illness varies considerably-with some methodologies utilising criteria previously developed for elderly populations. Given this lack of standardisation, improving the prescribing in this context requires an approach that is specifically designed and validated for populations with life-limiting illness.
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http://dx.doi.org/10.1136/bmjspcare-2015-000941DOI Listing
June 2017

Promoting the early detection of cancer: a systematic review of community pharmacy-based education and screening interventions.

Cancer Epidemiol 2015 Oct 10;39(5):673-81. Epub 2015 Aug 10.

Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Thornaby, Stockton-on-Tees, TS17 6BH, UK. Electronic address:

Background: Given that the burden of cancer is set to increase globally, strategies are needed to improve the early detection of cancer. As such, increasing focus is now placed on promoting the early detection of cancer through education and screening interventions. One healthcare setting that has significant potential in delivering these approaches is the community pharmacy.

Aims: This study aimed to systematically review the literature to identify and assess the current evidence for the role of community pharmacies in delivering early cancer detection initiatives.

Method: A systematic literature search of four databases was undertaken (Medline, Embase, CINAHL, PsycINFO) from inception to June 2015 to identify peer-reviewed intervention studies.

Results: A total of 3711 articles were identified from the search, of which twelve were included in the review. The studies focused on a range of different cancers and showed it is feasible to recruit patients to education and screening interventions within a community pharmacy setting. However, the interventions were poorly described in the literature.

Conclusion: There is significant potential for community pharmacy to deliver education and screening-based interventions to promote the early detection of cancer, but more evidence is needed to ascertain how interventions delivered in this setting impact on patient outcomes.
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http://dx.doi.org/10.1016/j.canep.2015.07.011DOI Listing
October 2015

Access all areas? An area-level analysis of accessibility to general practice and community pharmacy services in England by urbanity and social deprivation.

BMJ Open 2015 May 8;5(5):e007328. Epub 2015 May 8.

Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton-on-Tees, UK Centre of Health and Inequalities Research (CIHR), Durham University, Durham, UK Department of Geography, Durham University, Durham, UK.

Objectives: (1) To determine the percentage of the population in England that has access to a general practitioner (GP) premises within a 20 min walk (the accessibility); (2) explore the relationship between the walking distance to a GP premises and urbanity and social deprivation and (3) compare accessibility of a GP premises to that of a community pharmacy--and how this may vary by urbanity and social deprivation.

Design: This area-level analysis spatial study used postcodes for all GP premises and community pharmacies in England. Each postcode was assigned to a population lookup table and Lower Super Output Area (LSOA). The LSOA was then matched to urbanity (urban, town and fringe, or village, hamlet and isolated dwellings) and deprivation decile (using the Index of Multiple Deprivation score 2010).

Primary Outcome Measure: Living within a 20 min walk of a GP premises.

Results: Overall, 84.8% of the population is estimated to live within a 20 min walk of a GP premises: 81.2% in the most affluent areas, 98.2% in the most deprived areas, 94.2% in urban and 19.4% in rural areas. This is consistently lower when compared with the population living within a 20 min walk of a community pharmacy.

Conclusions: Our study shows that the vast majority of the population live within a 20 min walk of a GP premises, with higher proportions in the most deprived areas--a positive primary care law. However, more people live within a 20 min walk of a community pharmacy compared with a GP premises, and this potentially has implications for the commissioning of future services from these healthcare providers in England.
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http://dx.doi.org/10.1136/bmjopen-2014-007328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431167PMC
May 2015

Widening the scope for early cancer detection: identification of alarm symptoms by community pharmacies.

Int J Clin Pharm 2015 Jun 19;37(3):465-70. Epub 2015 Feb 19.

Whitworth Chemist Ltd., Scunthorpe, UK.

Background: Cancers are one of the leading causes of death in the world and, due to the aging population, incidence rates are set to rise. As such, considerable effort has been placed on initiatives that aid the early detection of cancer, as this may improve patient survival outcome. One such initiative is the development of guidelines that explain how and when patient reported alarm symptoms suggestive of an underlying malignancy should be referred to a specialist. However, despite being conveniently placed to deliver interventions to promote the early detection of cancer, it is not clear what role community pharmacists could have in the development and implementation of these guidelines.

Objective: To: (1) assess the frequency and mean of patient reported alarm symptoms in a community pharmacy setting; (2) determine the demographics of patients presenting with the alarm symptom; and (3) explore the relationship between deprivation index of the community pharmacy and average frequency of alarm symptoms per pharmacy.

Setting: Thirty-three community pharmacies in the North of England.

Method: A prospective study from September 2013 to February 2014. Each community pharmacy team was provided training in relation to alarm symptoms to ensure there was consistency in reporting. Deprivation tertiles for each community pharmacy were calculated using the IMD 2010 deprivation index. The data were analysed using a Kruskal-Wallis test in order to determine whether there were any statistically significant associations between average frequency of alarm symptoms presented per pharmacy and the deprivation tertile.

Main Outcome Measure: Frequency of patient reported alarm symptoms.
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http://dx.doi.org/10.1007/s11096-015-0078-3DOI Listing
June 2015

The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England.

BMJ Open 2014 Aug 12;4(8):e005764. Epub 2014 Aug 12.

Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton-on-Tees, UK Department of Geography, Durham University, Durham, UK.

Objectives: To: (1) determine the percentage of the population in England that have access to a community pharmacy within 20 min walk; (2) explore any relationship between the walking distance and urbanity; (3) explore any relationship between the walking distance and social deprivation; and (4) explore any interactions between urbanity, social deprivation and community pharmacy access.

Design: This area level analysis spatial study used postcodes for all community pharmacies in England. Each postcode was assigned to a population lookup table and lower super output area (LSOA). The LSOA was then matched to urbanity (urban, town and fringe or village, hamlet and isolated dwellings) and deprivation decile (using the Index of Multiple Deprivation score).

Primary Outcome Measure: Access to a community pharmacy within 20 min walk.

Results: Overall, 89.2% of the population is estimated to have access to a community pharmacy within 20 min walk. For urban areas, that is 98.3% of the population, for town and fringe, 79.9% of the population, while for rural areas, 18.9% of the population. For areas of lowest deprivation (deprivation decile 1) 90.2% of the population have access to a community pharmacy within 20 min walk, compared to 99.8% in areas of highest deprivation (deprivation decile 10), a percentage difference of 9.6% (8.2, 10.9).

Conclusions: Our study shows that the majority of the population can access a community pharmacy within 20 min walk and crucially, access is greater in areas of highest deprivation--a positive pharmacy care law. More research is needed to explore the perceptions and experiences of people--from various levels of deprivation--around the accessibility of community pharmacy services.
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http://dx.doi.org/10.1136/bmjopen-2014-005764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4156797PMC
August 2014

Patients with advanced lung cancer: is there scope to discontinue inappropriate medication?

Int J Clin Pharm 2013 Apr 11;35(2):181-4. Epub 2012 Dec 11.

Department of Pharmacy, Health and Well-being, Faculty of Applied Sciences, University of Sunderland, Wharncliffe Street, Sunderland, SR1 3SD, UK.

Background: Polypharmacy-taking five or medications per day-is common in lung cancer patients. This patient group is prescribed medication to control acute symptoms associated with cancer and also to prevent or treat other long-term conditions. These medications increase the pill burden for the patient and also the probability of developing a drug-related toxicity.

Objective: To assess the prevalence of inappropriate medication in patients taking erlotinib for the treatment of advanced non-small cell lung cancer.

Method: This was a multicentre study across three sites in the North of England. Medication histories for patients receiving erlotinib were retrospectively extracted from medical notes and assessed by the clinical team (a consultant pharmacist, nurse specialist and clinical oncologist) to determine if the medication was appropriate or inappropriate. The clinical team considered the following factors when deciding if the medication was appropriate or inappropriate: remaining life expectancy of the patient, time until benefit of the treatment, goals of care and treatment targets.

Results: Among the 20 patients assessed, 19 (95 %) according to the clinical team were taking medications that were inappropriate. The mean number of medications the patients were taking was 8 (range 1-16) and the most common class of medication used were drugs affecting the Central Nervous System. In addition, there were 11 patients (55 %) who were taking erlotinib in combination with a proton pump inhibitor (PPI)-a clinically significant drug interaction that impairs the absorption of erlotinib.

Conclusions: Patients taking erlotinib for the treatment of advanced non-small cell lung cancer take many inappropriate medications for the treatment or prevention of long-term conditions. These patients should have their medications reviewed in the context of their original therapeutic goals.
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http://dx.doi.org/10.1007/s11096-012-9731-2DOI Listing
April 2013
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